T Nation

TRT at 22, Could Diet Be Underlying Issue?

I saw an endocrinologist for low testosterone. She ordered a bunch of tests and also an MRI of my pituitary gland to rule out a tumor or any injury. Have you had an MRI done yet? She is against TRT as there’s too many side effects. She actually recommends Clomid, which stimulates the Pituitary Gland, which in return raises your testosterone levels (assuming your pituitary gland is fine). Check out this study:


Also another good article regarding Clomid for TRT:

[quote]ridinhighspeeds wrote:
I saw an endocrinologist for low testosterone. She ordered a bunch of tests and also an MRI of my pituitary gland to rule out a tumor or any injury. Have you had an MRI done yet? She is against TRT as there’s too many side effects. She actually recommends Clomid, which stimulates the Pituitary Gland, which in return raises your testosterone levels (assuming your pituitary gland is fine). Check out this study:


Also another good article regarding Clomid for TRT:
http://shiramillermd.com/blog/clomid-men-testosterone-alternative.html[/quote]

Hi, yes im familiar with the actions of clomid raising LH, however its most likely once you stop the clomid the pituitary will return back to original output, so its only a short term fix really to aid fertility storage etc… From what iv read a succesful pituitary restart is very unlikely.

Im having an MRI soon, but its likely to show nothing tumor wise as it would be down to my head trauma.

Blood count suggests iron deficiency and/or a GI bleed which can be detected with an occult blood test. Any digestive problems?

You are eating natural foods but note that goiter and related mental retardation was the rule in most of the world prior to iodized salt. You are iodine deficient and have thyroid problems. Your body temperatures are low because your are not getting enough fT3 inside your cells. Read the thyroid basics sticky.

[quote]KSman wrote:
Blood count suggests iron deficiency and/or a GI bleed which can be detected with an occult blood test. Any digestive problems?

You are eating natural foods but note that goiter and related mental retardation was the rule in most of the world prior to iodized salt. You are iodine deficient and have thyroid problems. Your body temperatures are low because your are not getting enough fT3 inside your cells. Read the thyroid basics sticky.

[/quote]

No apparant digestive problems apart from usual undigested fibre (vegies) in stool, mother suffers from real bad IBS though.

Yes I actually had thirst problems and thought my electrolite balance could be off so started adding sea salt, but as iv seen in the thryoid sticky that doesnt contain much iodine.
Should I consult my doctor before starting the iodine replenishment regime in the sticky?

What judgment do you have on the link between my thryroid and pituitary? am i just unfortunate and have both issues or is one influencing the other - cause/causation/coincidence.

I know in the thyroid sticky you said it can be either or, and that without fixing thryoid fixing T with TRT may still leave me with the same symptoms…

[quote]shadow77 wrote:

[quote]ridinhighspeeds wrote:
I saw an endocrinologist for low testosterone. She ordered a bunch of tests and also an MRI of my pituitary gland to rule out a tumor or any injury. Have you had an MRI done yet? She is against TRT as there’s too many side effects. She actually recommends Clomid, which stimulates the Pituitary Gland, which in return raises your testosterone levels (assuming your pituitary gland is fine). Check out this study:


Also another good article regarding Clomid for TRT:
http://shiramillermd.com/blog/clomid-men-testosterone-alternative.html[/quote]

Hi, yes im familiar with the actions of clomid raising LH, however its most likely once you stop the clomid the pituitary will return back to original output, so its only a short term fix really to aid fertility storage etc… From what iv read a succesful pituitary restart is very unlikely.

Im having an MRI soon, but its likely to show nothing tumor wise as it would be down to my head trauma.[/quote]

I asked her the exact same question and she said most people go on clomid for around 6 months to raise their testosterone levels back to normal ranges. After stopping the pill for 6 months, their levels remained in the normal range and it was due to the pituitary “reboot” as she put it. The other benefit of clomid is that it actually helps raise your sperm production and doesn’t shrink your balls.

[quote]ridinhighspeeds wrote:

[quote]shadow77 wrote:

[quote]ridinhighspeeds wrote:
I saw an endocrinologist for low testosterone. She ordered a bunch of tests and also an MRI of my pituitary gland to rule out a tumor or any injury. Have you had an MRI done yet? She is against TRT as there’s too many side effects. She actually recommends Clomid, which stimulates the Pituitary Gland, which in return raises your testosterone levels (assuming your pituitary gland is fine). Check out this study:


Also another good article regarding Clomid for TRT:
http://shiramillermd.com/blog/clomid-men-testosterone-alternative.html[/quote]

Hi, yes im familiar with the actions of clomid raising LH, however its most likely once you stop the clomid the pituitary will return back to original output, so its only a short term fix really to aid fertility storage etc… From what iv read a succesful pituitary restart is very unlikely.

Im having an MRI soon, but its likely to show nothing tumor wise as it would be down to my head trauma.[/quote]

I asked her the exact same question and she said most people go on clomid for around 6 months to raise their testosterone levels back to normal ranges. After stopping the pill for 6 months, their levels remained in the normal range and it was due to the pituitary “reboot” as she put it. The other benefit of clomid is that it actually helps raise your sperm production and doesn’t shrink your balls. [/quote]

In theory yes, iv seen little long term success with such ‘restarts’ though, but depends why your pituatory isnt functioning i guess, worth a shot though for sure

Interested in your case for sure. I’m in a similar situation (low LH/FSH/Testosterone, and low-ish FT4 and FT3). Clomid didn’t work for me. Only got my LH/FSH up to 2 (which is where you are at). HCG does seem to help after a while. Something is preventing my pituitary from sending out enough LH/FSH (or maybe the hypothalamus from sending GnRH). Trying to get to the bottom of it. MRI came back clear.

I only recently started Iodine, and improved my temps after a good 6 weeks. At first, I was below 36 C waking up, and now I’m right at 37 C or .1 or .2 under.

Waiting for full panel bloodwork.

[quote]kris90 wrote:
Interested in your case for sure. I’m in a similar situation (low LH/FSH/Testosterone, and low-ish FT4 and FT3). Clomid didn’t work for me. Only got my LH/FSH up to 2 (which is where you are at). HCG does seem to help after a while. Something is preventing my pituitary from sending out enough LH/FSH (or maybe the hypothalamus from sending GnRH). Trying to get to the bottom of it. MRI came back clear.

I only recently started Iodine, and improved my temps after a good 6 weeks. At first, I was below 36 C waking up, and now I’m right at 37 C or .1 or .2 under.

Waiting for full panel bloodwork.[/quote]

Interesting I haven’t had GnRH done to tell, but I’m thinking from my head accident my pituitary may be a non responder to a restart…

Did you do the iodine protocol on this site or something your doctor recommended?

Is your test low range? not thinking of TRT? what age are you?

Just read through your help threat, interesting read and its all very similar to what I’m experiencing but iv yet to go down the hpta restart route…

I see three options.

1 - Restart (HCG/Clomid) and then see what the outcome is (although statistically its unlikely to help long term)
2 - Low dose TRT with HCG to get baseline numbers up but hopefully remain fertile (if I’m fertile now test back friday)
3 - Thyroid issue could be fixed with iodine supplement or full blown thyroid treatment
Bonus 4 - Either TRT will fix Red blood etc or iron deficiency.

I followed KSMan’s advice and focused on getting around 0.75g of Iodine (although not as aggressive as 2 weeks). I ended up starting out small with a liquid solution (1mg) and worked my way up slowly to 50mg per day, and now I dropped it back down to 800mcg per day, as well as salt my foods with Iodized Sea Salt, and I consume half Nori (seaweed) sheet daily which has about 150mcg of Iodine. Ended up buying a new thermometer because I suspected my old was inaccurate. I still sometimes feel cold even though my temperatures are now optimal.

My total T levels always end up falling to around 12 nmol/L when I’m off all meds. With low dose HCG I got up to around 16 nmol/L, and had my Free T levels close to midrange. I’m 24 years old and have been going through this for a few years now. I actually felt pretty good after about 6 weeks on the HCG. I’m back on HCG now (been about 5 weeks) and haven’t felt significant improvements yet (although libido is back which is nice).

As far as treatments, if you’ve had a low LH/FSH for a long time, best to start out on HCG to atleast bring testes back online. If you have secondary hypogonadism, you will respond well to HCG. Given your low LH/FSH, this is guaranteed to work. I would say after a few months of HCG, attempt a restart. You only need to take about 25mg/ED or EOD, but I would get bloodwork within 2-4 weeks of starting Clomid to see if that even works, because if LH/FSH does not increase (similar to my situation), you’ll want to bail and go back to HCG until you can figure out a cause.

Since your temperatures are low, may as well kill 2 birds with 1 stone, and start with Iodine. That way, if low thyroid function was causing your low LH/FSH/Testosterone, you’ll already be on your way to fixing the issue(s). Might want to get the thyroid antibodies checked to rule out autoimmune (Hashimoto’s and Graves). If that’s clear, it’s almost certainly an Iodine deficiency. Supplement with Selenium if you go the Iodine route (especially high doses).

Thanks

How does the hcg work if your testes are fine but pituitary is the problem? Surely only clomid is beneficial to raise LH and this stimulate the testes more?

How come you have avoided TRT? Not thought about low dose TRT and hcg to keep yourself functioning and outputting a bit of T?

Have you looked into running hcg/clomid long term or?

[quote]shadow77 wrote:
Thanks

How does the hcg work if your testes are fine but pituitary is the problem? Surely only clomid is beneficial to raise LH and this stimulate the testes more?

How come you have avoided TRT? Not thought about low dose TRT and hcg to keep yourself functioning and outputting a bit of T?

Have you looked into running hcg/clomid long term or?[/quote]

HCG is an LH analog. It replaces the function of LH from the pituitary, so as long as the testes are working, HCG will provide the same stimulation that LH would normally.

I originally wanted TRT when I found out my levels were low. I’ve actually injected T before (done steroid cycles) and felt incredible on it, but now I realise I’m so young, and I’m more determined to find the cause and cure myself naturally. I don’t think I’m ready to commit to lifelong TRT. I also just recently had a daughter, and I will want to have another child, so I prefer to not compromise my fertility.

I would probably stick to HCG long-term if we absolutely could not find a cause. Maybe add in small T injections if need be once fertility is no longer a concern.

[quote]kris90 wrote:

[quote]shadow77 wrote:
Thanks

How does the hcg work if your testes are fine but pituitary is the problem? Surely only clomid is beneficial to raise LH and this stimulate the testes more?

How come you have avoided TRT? Not thought about low dose TRT and hcg to keep yourself functioning and outputting a bit of T?

Have you looked into running hcg/clomid long term or?[/quote]

HCG is an LH analog. It replaces the function of LH from the pituitary, so as long as the testes are working, HCG will provide the same stimulation that LH would normally.

I originally wanted TRT when I found out my levels were low. I’ve actually injected T before (done steroid cycles) and felt incredible on it, but now I realise I’m so young, and I’m more determined to find the cause and cure myself naturally. I don’t think I’m ready to commit to lifelong TRT. I also just recently had a daughter, and I will want to have another child, so I prefer to not compromise my fertility.

I would probably stick to HCG long-term if we absolutely could not find a cause. Maybe add in small T injections if need be once fertility is no longer a concern.[/quote]

Such a similar situation to myself, I also done a Ph cycle 1.5 years ago and wonder if that’s the cause…

You say hcg long term, I assume there’s no long term safety studies? And I assume you came off it that once to see if you recovered to normal levels?

I too want children, had a sperm analysis done results back Friday to see if I’m fertile currently, but I’d be interested in a hcg run or try a restart for the time being before going Trt totally…

My endo did say a low Trt dose with hcg would keep me fertile and get my ranges better, was interesting to see I’m low estro as well as iv always felt like I had high estro (emotional, love handles, puffy nips even at low bf) but I guess that’s due to the low test…

How do you plan on running hcg long term if you can’t find the cause?

My first endo laughed at hcg and said that’s for pregnant women… Great haha

Q: “What judgment do you have on the link between my thyroid and pituitary?”

Thyroid issues affect all tissues in the body so there may be direct effects on the pituitary. We see many guys who land here with T problems who have thyroid/iodine issues. We know that hypothyroidism can lower T levels [secondary hypogonadism], so its really not a big stretch to think that iodine deficiencies are driving some of the issues that we see here. There is not hard data, only what we see with the guys here. We sometimes see restored thyroid function restore T levels in younger guys, but is not often reported on this forum.

Q: HPTA Restart: This works when it works and is worth trying in younger males. Having thyroid in order would be useful as well. Restarts can fail from estrogen rebound, so tapering and landing on low dose AI will improve the odds. If undetected elevated prolactin exists, restart will fail. If hCG or SERM’s are utilized and doses are high, the LH receptors will be used to high stimulation and the testes might then perform poorly after the restart that yields normal LH stimulation. In any case, if the original cause of the problem persists, the outcome is probably not going to be good. When on a SERM for a while, if tested LH/FSH levels are bad, go to TRT [no taper required]. If LH/FSH levels are good but T is low, goto TRT [no taper required]. If on hCG and T levels are low, go to TRT [no taper required]. This is not mysterious and and most should be able to understand these issues.

Thanks ksman big help!

I’ll get working on the thyroid as per sticky.

In relation to the restart…

Some say go hcg then clomid to prime the tested then stimulate LH with the clomid, however couldn’t the hcg first suppress the pituitary even more so.

I’d think given my situation and the fact that my test isn’t rock rock bottom (can still function sexually etc) it would be better to start with the clomid, get bloods done then taper off to see if it maintains higher output.

If it doesn’t then maybe buy some time on hcg, with the outcome likely being TRT. Unless I can find a route cause e.g. Hypothalamus gland but I’m not sure how you would determine that…

But yes I agree I think a restart is worth trying, just need to figure out the best way going about it… I know clomid can have some nasty sides too.

[quote]shadow77 wrote:

Such a similar situation to myself, I also done a Ph cycle 1.5 years ago and wonder if that’s the cause…

You say hcg long term, I assume there’s no long term safety studies? And I assume you came off it that once to see if you recovered to normal levels?

I too want children, had a sperm analysis done results back Friday to see if I’m fertile currently, but I’d be interested in a hcg run or try a restart for the time being before going Trt totally…

My endo did say a low Trt dose with hcg would keep me fertile and get my ranges better, was interesting to see I’m low estro as well as iv always felt like I had high estro (emotional, love handles, puffy nips even at low bf) but I guess that’s due to the low test…

How do you plan on running hcg long term if you can’t find the cause?

My first endo laughed at hcg and said that’s for pregnant women… Great haha [/quote]

I doubt the PH cycle is the cause of your issues. I really think if everything was functioning properly, you would have bounced back. My Urologist thinks the same about me when I told him my history of AAS use.

I definitely think HCG would be safe long-term. Structurally, it’s nearly identical to LH, and as humans, we are all exposed to HCG (think when your mother was pregnant with you). And since I get human grade (comes directly from a pregnant woman) I’m not too worried. Yes, basically, I would always attempt to come off the HCG (or T when I was running cycles) by using Clomid and/or Nolva, but SERMs were never able to boost my LH/FSH by very much, and my T levels slowly end up crashing (even while on the SERM). So something most be blocking one of the signals in the pathway (either GnRH is too low to boost LH/FSH, or GnRH is very high but the pituitary is not responding).

I would definitely try a restart first. Do what you can to fix yourself naturally. I would think that if you took enough HCG along with small T injections, you should still be able to maintain spermatogenesis and remain fertile.

I also have low estro (due to low T, so there’s low aromatization). For long term HCG, I would probably shoot 250 IU EOD for a while and see what that gets me. It got me feeling pretty good last time, but T levels were only midrange. I find when I first get on HCG, I feel my Estradiol climb too high, so I have to stick to the lower doses, but then it levels out after a month or so. Once I get bloodwork done on the 250 IU EOD, and my T:E2 ratio is good, I may add T injections to boost my T a little higher (maybe around 700-800ng/dl) but this is only the plan if I go that route (long term).

[quote]kris90 wrote:

[quote]shadow77 wrote:

Such a similar situation to myself, I also done a Ph cycle 1.5 years ago and wonder if that’s the cause…

You say hcg long term, I assume there’s no long term safety studies? And I assume you came off it that once to see if you recovered to normal levels?

I too want children, had a sperm analysis done results back Friday to see if I’m fertile currently, but I’d be interested in a hcg run or try a restart for the time being before going Trt totally…

My endo did say a low Trt dose with hcg would keep me fertile and get my ranges better, was interesting to see I’m low estro as well as iv always felt like I had high estro (emotional, love handles, puffy nips even at low bf) but I guess that’s due to the low test…

How do you plan on running hcg long term if you can’t find the cause?

My first endo laughed at hcg and said that’s for pregnant women… Great haha [/quote]

I doubt the PH cycle is the cause of your issues. I really think if everything was functioning properly, you would have bounced back. My Urologist thinks the same about me when I told him my history of AAS use.

I definitely think HCG would be safe long-term. Structurally, it’s nearly identical to LH, and as humans, we are all exposed to HCG (think when your mother was pregnant with you). And since I get human grade (comes directly from a pregnant woman) I’m not too worried. Yes, basically, I would always attempt to come off the HCG (or T when I was running cycles) by using Clomid and/or Nolva, but SERMs were never able to boost my LH/FSH by very much, and my T levels slowly end up crashing (even while on the SERM). So something most be blocking one of the signals in the pathway (either GnRH is too low to boost LH/FSH, or GnRH is very high but the pituitary is not responding).

I would definitely try a restart first. Do what you can to fix yourself naturally. I would think that if you took enough HCG along with small T injections, you should still be able to maintain spermatogenesis and remain fertile.

I also have low estro (due to low T, so there’s low aromatization). For long term HCG, I would probably shoot 250 IU EOD for a while and see what that gets me. It got me feeling pretty good last time, but T levels were only midrange. I find when I first get on HCG, I feel my Estradiol climb too high, so I have to stick to the lower doses, but then it levels out after a month or so. Once I get bloodwork done on the 250 IU EOD, and my T:E2 ratio is good, I may add T injections to boost my T a little higher (maybe around 700-800ng/dl) but this is only the plan if I go that route (long term).

[/quote]

Thanks for the reply again very informative…

Putting this into practicality, I guess I should follow this route

  1. Clomid restart, 2 months 25mg then taper off
    if unnsecseful

  2. HCG 250IU EOD, then possibly low dose T on top

What did your T levels rise to on HCG? Did you stop the successful HCG due to still not being able to get into high range T or because you wanted to stop to try a restart?

Do you think you will drop off HCG at some point and go full TRT?

[quote]shadow77 wrote:
Thanks for the reply again very informative…

Putting this into practicality, I guess I should follow this route

  1. Clomid restart, 2 months 25mg then taper off
    if unnsecseful

  2. HCG 250IU EOD, then possibly low dose T on top

What did your T levels rise to on HCG? Did you stop the successful HCG due to still not being able to get into high range T or because you wanted to stop to try a restart?

Do you think you will drop off HCG at some point and go full TRT?
[/quote]

T levels to 16.4 nmol/L (range was 6.1-27.1) so about midrange (I think that’s just under 500ng/dL). I felt really good though, good body composition, high energy and stamina, and improved mood and sense of well being. My Estradiol was only 63 pmol/L though (which is about 17 pg/mL) so basically what that tells me, is I could afford to increase my T since Estradiol was a bit on the low side. So my new plan is to get my levels back to this point, and then increase HCG dose to maybe 400 IU EOD and see what my levels get to.

The reason I stopped HCG was to see if a restart would be successful. I wanted to try it, and so did my Urologist since MRI showed no damage to my Pituitary. Unfortunately it did not work for whatever reason.

I doubt I will ever drop HCG, even if I add T injections. The reason being is that it prevents organ failure (testicular). I’d rather have my testes continue to work all my life, and HCG is also important for supporting the P450 pathway (Pregnenolone production from Cholesterol). I feel like HCG boosts my adrenals and it’s probably through this pathway.

[quote]kris90 wrote:

[quote]shadow77 wrote:
Thanks for the reply again very informative…

Putting this into practicality, I guess I should follow this route

  1. Clomid restart, 2 months 25mg then taper off
    if unnsecseful

  2. HCG 250IU EOD, then possibly low dose T on top

What did your T levels rise to on HCG? Did you stop the successful HCG due to still not being able to get into high range T or because you wanted to stop to try a restart?

Do you think you will drop off HCG at some point and go full TRT?
[/quote]

T levels to 16.4 nmol/L (range was 6.1-27.1) so about midrange (I think that’s just under 500ng/dL). I felt really good though, good body composition, high energy and stamina, and improved mood and sense of well being. My Estradiol was only 63 pmol/L though (which is about 17 pg/mL) so basically what that tells me, is I could afford to increase my T since Estradiol was a bit on the low side. So my new plan is to get my levels back to this point, and then increase HCG dose to maybe 400 IU EOD and see what my levels get to.

The reason I stopped HCG was to see if a restart would be successful. I wanted to try it, and so did my Urologist since MRI showed no damage to my Pituitary. Unfortunately it did not work for whatever reason.

I doubt I will ever drop HCG, even if I add T injections. The reason being is that it prevents organ failure (testicular). I’d rather have my testes continue to work all my life, and HCG is also important for supporting the P450 pathway (Pregnenolone production from Cholesterol). I feel like HCG boosts my adrenals and it’s probably through this pathway.[/quote]

Thanks for another useful reply.

Its making me think id like to try hcg first to finally feel normal! but at the same time a restart is probably best served before being on hcg for too long…

Do you have any understanding of how low dose TRT + HCG would work to increase total test? isn’t it a bit like a double message? one end your introducing test and on the other asking your body to produce more…
Or is it a case that exogenous T prevents LH production, and thus the HCG is just replacing that… So in effect you get your exogenous T plus any normal T your making from the HCG…

Thanks

[quote]shadow77 wrote:
Thanks for another useful reply.

Its making me think id like to try hcg first to finally feel normal! but at the same time a restart is probably best served before being on hcg for too long…

Do you have any understanding of how low dose TRT + HCG would work to increase total test? isn’t it a bit like a double message? one end your introducing test and on the other asking your body to produce more…
Or is it a case that exogenous T prevents LH production, and thus the HCG is just replacing that… So in effect you get your exogenous T plus any normal T your making from the HCG…

Thanks[/quote]

You could definitely try HCG first. I find it’s the fastest way to get your testes back online. Even if you just went on for 1 month and then switched to Clomid or Nolva.

I think the reason for using T with the HCG is because HCG is best used in smaller doses because it seems to cause higher aromatisation (there was some evidence of this, but can’t find it now). So basically, a lot of people have a tough time getting their T levels to the top of the range without having too much Estradiol on HCG alone. So atleast with small dose HCG, if you can get to midrange without excess Estradiol, small T injections can help get your T levels into the high end with a lesser increase in Estradiol than if HCG was used solely at a higher dose. That’s my theory anyways, but I’m going to try to get my T levels above midrange with HCG alone since it didn’t seem to spike my Estradiol.

[quote]kris90 wrote:

[quote]shadow77 wrote:
Thanks for another useful reply.

Its making me think id like to try hcg first to finally feel normal! but at the same time a restart is probably best served before being on hcg for too long…

Do you have any understanding of how low dose TRT + HCG would work to increase total test? isn’t it a bit like a double message? one end your introducing test and on the other asking your body to produce more…
Or is it a case that exogenous T prevents LH production, and thus the HCG is just replacing that… So in effect you get your exogenous T plus any normal T your making from the HCG…

Thanks[/quote]

You could definitely try HCG first. I find it’s the fastest way to get your testes back online. Even if you just went on for 1 month and then switched to Clomid or Nolva.

I think the reason for using T with the HCG is because HCG is best used in smaller doses because it seems to cause higher aromatisation (there was some evidence of this, but can’t find it now). So basically, a lot of people have a tough time getting their T levels to the top of the range without having too much Estradiol on HCG alone. So atleast with small dose HCG, if you can get to midrange without excess Estradiol, small T injections can help get your T levels into the high end with a lesser increase in Estradiol than if HCG was used solely at a higher dose. That’s my theory anyways, but I’m going to try to get my T levels above midrange with HCG alone since it didn’t seem to spike my Estradiol.
[/quote]

Thanks makes total sense, I’m going to talk with my endo saturday but he was up for HCG/RESTART… Think id rather to HCG for a period and then think about trying a clomid restart, if I’m feeling good doubt ill want to risk it though haha!